心肺复苏低温治疗—培训课件.pptVIP

Risk factors for rebound hyperthermia Crit Care Med 2009;37:1101-20. The presence of rebound hyperthermia is associated with anincreased risk of in-hospital mortality. 40 of the 99 (40.4%) patients without rebound hyperthermia experienced any cause in-hospital death. This is compared to 27 of the 42 (64.3%) patients who experienced rebound hyperthermia (OR: 2.66; 95% CI: 1.26–5.61; p = 0.011). The risk of rebound hyperthermia. Resuscitation 2013;84:927-34. Treat fever until at least 72 hrs after cardiac arrest.  Reasons for early rewarming  Arrhythmia (severe bradycardia, recurrent ventricular fibrillation) Severe circulatory instability Bleeding Uncontrolled lactate rise  conclusion selecting and maintaining a constant temperature between 32oC and 36oC during TTM (Class I). TTM be maintained for at least 24 hours after achieving target temperature (Class IIa). * As you know the prognosis for cardiac arrest is very poor. Only 2% survive with good neurological outcome. There is not a lot being done with these patients. ? of these arrests occurred outside of the hospital, but ? occurred inside the hospital. 心脏停搏的预后是很差的，只有2% 的幸存者保有好的神经性功能，这些患者不用再做更多的事情。而3/4的患者心脏停搏发生在院外，1/4发生在院内 There is a lot of room for improvement on how we treat these patients. 如何治疗这些患者还有很多的空间可以改善 Therapeutic hypothermia in Post–Cardiac Arrest Care 2015 VS 2010 心脏骤停的流行病学 400,000 骤停 / 每年在 U.S.A医院 3 / 4 门急诊 1 / 4 住院患者 hypoxemia ischemia reperfusion multiple organ systems Influence of cardiac arrest and resuscitation 低温治疗：是一种以物理方法将患者的体温降低到预期水平而达到治疗疾病目的的方法。 低温疗法是荷兰物理学家卡曼林?昂内斯（1853-1926）发明的，被誉为“低温学之父。” 低温治疗的分类 分类 英文名称 目标温度 轻度低温 mild hypothermia 33－35℃ 亚低温(mild hypothermia)，亚低温状态下，对心脑肺的保护作用与深度低温相似，但无明显不良反应 中度低温 moderate hypothermia 28－32℃ 深度低温 profound hypothermia 17－27℃ 28℃以下低温容易引起低血压和心律失常等并发症，目前较少使用 超深度低温 ultraprofound hypothermia ≤16℃ 低温治疗作用机制的新观念 降低脑的代谢水平，减低氧耗，改善并恢复能量供给； 抑制氧自由基产生，减轻氧化应激损伤； 下调炎症介质的产生和炎症细胞的集聚，减轻炎症损伤； 减低神经细胞及心肌细胞凋亡。